Healthcare Provider Details

I. General information

NPI: 1194726976
Provider Name (Legal Business Name): TAMARA LYNN KESSEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22347 NORTHWESTERN PIKE
ROMNEY WV
26757-6343
US

IV. Provider business mailing address

22347 NORTHWESTERN PIKE
ROMNEY WV
26757-6343
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-3838
  • Fax: 304-822-7140
Mailing address:
  • Phone: 304-822-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number44556
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44556
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: